Exposure And Worsening Of Symptoms With Complex Trauma

[anthony]

So if you are in a situation where people are pushing you back into the middle of the highway in peak hour traffic (while THEY are wearing blindfolds) and where you've already been hit by a truck 3 times....thats a real fear right?

Is this a metaphor to justify therapy modelaties, or actuality, being there is three people blind folded 'actually' pushing you back into a highway in peak hour traffic? One is real, the other is perceived and an excuse to justify reality for fiction. It might 'feel' real, but its not. There is a vast difference between real threat and perceived threat.

 

[Jacquie]

Personally if they'd done it 3 times I'd say you're a total dickhead to not get out the way if you saw them coming. The whole thing with triggers as it seems, is the actual biological learning system.

If I hear an explosion YOU BET I am down with hands over my head! Thats what keeps you alive. Are we to worry about what Joe Smith standing there thinks? Yanno the guy who just had his head removed by part of the gas tank that went up.

Thats a perceived threat that might or might not have harmed you. But could.

Take another example. I am freaked out by purple mohawks. Well ok a purple mohawk never hurt me. Someone WITH a purple mohawk hurt me. But if I see a purple mohawk it 'reminds me' of a past event that is NOT happening now, but I feel the emotions of that event.

Then I go hang out with heaps of punk rockers and purple mohawks (nice ones) until that association is broken.

The event is still real. The association is skewed to something that did not warn of danger but which has imprinted as the trigger.

There is no perceived threat (current) but a reminder of a past event, which defines a reaction (current) to the past event which 'was' a threat.

So exposure therapy is about changing associations? Room full of purple mohawks? (as the example). If it is, then its a desensitisation program.

And its the same thing paedophiles use on their potential victims. Exactly the same. Very effective for someone who has never been subjected to it, but potentially terrifying to anyone who has.

 

[anthony]

Exposure therapy is desensitization, yes... in a controlled manner, using perceived threat vs. real threat.

And you are confused in one of your examples, as an explosion is a 'real threat' not a 'perceived threat' situation.

Now you are relating a positive therapy method to justify that is what paedophiles use. That is not correct at all.

Some abusers use time and exposure to subjugate their victims. That is not exposure therapy, being a sense of facing your fears... you are confusing that with being victimised and abused, which is not desensitisation, its outright abuse.

You continue to try and justify to not do something that is used for positive reinforcement vs. being victimised and abused, which is negative reinforcement.

EMDR, uses exposure therapy. DBT, uses exposure therapy. CTT, uses exposure therapy. Seeking Safety, uses exposure therapy. Then you also have, Prolonged Exposure therapy, which uses both cognitive and exposure components.

Every therapy uses cognitive and exposure components, whether you know it or not... so trying to justify that exposure therapy is not right for you, is trying to justify that no therapy is right for you... and you simply love misery instead. Some people feel that way, and its an individual choice. Some choose to endure the short term pain, accepting the long term gain therapy provides.

My own methods... I believe the faster you get through it in one condensed dosage, the less you have to continue to suffer and the faster you come out the other side and start to see really good positive improvement.

 

[maddog]

I believe that trauma therapy is about processing past events with the skills, strategies and functioning that are available to you in the present. In the case of childhood trauma, for example, it is about reinterpreting what are often dangerously skewed memories and perceptions (owing to emotional distortion, immaturity or the cognitively limiting effects of present trauma) with the rationality, maturity and clarity of an objective healthy view. It's why we often need a therapist to work with us - often we're not able to form and internalise those rational objective states without the guidance and input of someone else.

Some level of safety, stability, emotional awareness and regulation are definitely critical before trauma therapy can be safe, let alone efective. Start without those things and you risk enormous dissociation at best, and extreme personal danger and retraumatisation at worst. Personally, for me, it's why trauma therapy as such was only possible and productive after many months of prior therapy, predominently of the CBT and mindfulness varieties.

And yes, it gets worse, much much worse, before it gets better, assuming it does get better of course. The jury's still out on that one for me, though I try hard to keep faith in all that I rationally know to be true in that respect.

 

[doglover]

Every therapy uses cognitive and exposure components, whether you know it or not... so trying to justify that exposure therapy is not right for you, is trying to justify that no therapy is right for you...

Aha that's what I needed to hear, thank you. I definitely want to get better. I'm just used to avoiding!

My own methods... I believe the faster you get through it in one condensed dosage, the less you have to continue to suffer and the faster you come out the other side and start to see really good positive improvement.

That makes sense to me. I think if or when I start to get better recall for specific events I may try the method again as you outline it. Right now I'm dancing with the feelings and memories that do come, as they come, but it's slow in coming. Reading lots of difficult material on symptoms, abuse, etc. and feeling nothing about it. Still trying to convince myself it's okay to remember and feel the memories. I'm just still ambivalent about it right now, since I've coped this way for so long.

You helped me see this is something I'll need to be ready to do, one way or the other, if I really want to heal. And I do.

 

[Tinyflame]

... so trying to justify that exposure therapy is not right for you, is trying to justify that no therapy is right for you...I believe the faster you get through it in one condensed dosage, the less you have to continue to suffer and the faster you come out the other side and start to see really good positive improvement.

In other words, do you mean Anthony, (if I get this right) face and do exactly everything that you would avoid. Dive right in.

 

[maddog]

I do think that trauma therapy, like any sort of therapy I suppose, usually involves doing the things that feel most foreign an alien and even intensely threatening to the self. Our ego defense mechanisms have evolved over generations of humanity to the point where they are actually very good at protecting us from things that are distressing or damaging to hold in consciousness. Attacking those ego defenses and making them take a back seat, which is in effect what we have to do in therapy, is likely to feel like the most unnatural and non-instinctual process in the world, especially as it involves processes and behaviours, like emotional self expression and trust, which are so counter-intuitive to many of us.

I think there is a bloody good rational argument in support of leaving well enough alone and leaving the past in the past, provided you can keep it there of course. I like the pantry analogy. I have a similar one when I think of my memories as being boxes of belongings which have been packed up tight and sealed closed for my entire life. As long as they are closed tight and their contents invisible, then life continues doggedly on. In my case it lacked anything remotely resembling contentment or fulfillment and the packing tape on those boxes had been gradually splitting and cracking long before I ever recognized it.

But then life turned a few corners and conspired against my ego defenses, and all of those contents came spilling out. And now, as they overwhelm my entire life, the only way of putting them back in those boxes is to sort through them and reorganise them in a way that makes sense.

I know, a kind of silly analogy, but it works for me for some reason. There is something about the mental image of upended boxes of rubbish strewn all over my life that accurately reflects the turmoil and devastation that I feel to have had them dumped out at my feet.

I do believe, in theory, that long term progress and stability can only be achieved through dealing with that trauma and those memories in some form or other. What that looks like, how intensely and graphically and in what way that happens for people is a very individual thing. But until it's done, I can't help but feel that life is always only a ticking time bomb and a case of when, not if, the past will leap up to trip us over.

But believe me, I understand the resistance. Perhaps a dozen times a day I long for the life I had beforehand, the empty, soulless, dead life that it was, but the life thatlacked the horror of ancient traumas that now feel more current and real than my current reality. If I could stuff the contents back into those boxes and pretend that none of it ever came out, then I would.

But i can't...

Maddog

 

[anthony]

Some level of safety, stability, emotional awareness and regulation are definitely critical before trauma therapy can be safe, let alone efective. Start without those things and you risk enormous dissociation at best, and extreme personal danger and retraumatisation at worst.

Absolutely... hence go back to previous post outlining exactly these points....

Firstly... you don't have to look at your past as your starting point. There are a few key points which many often miss when it comes to trauma therapy of any type, being:

• Your home environment must be stable, safe and supportive.
• You must be able to manage your emotional stability during trauma therapy (techniques, cognitive functioning).
• You must know relaxation and stress relief techniques, and have them implemented within your life, prior to trauma therapy.

In other words, do you mean Anthony, (if I get this right) face and do exactly everything that you would avoid. Dive right in.

It is said simply, yes... but its always been a little more complicated to perform.

The complication is that you must first have all the above points, if you are talking about outright exposure to irrational fears only, then you should have also got the majority of your cognitive trauma processing done, so you have all the self skills to get yourself through such exercises.

If the above is met... then yes, literally jump in and begin exposing yourself to irrational fears, accepting that IT IS going to severely heighten your symptoms, hence you must be able to manage the symptoms and thoughts, changing the irrational negatives that keep this fear instilled within you, and replace them out with the actual reality and positives you have obtained.

An irrational fear is shopping centers, being a big one upon most with PTSD. Crowds specifically.

Shopping centers are 99.9% safe environments, as they're public and they have lots of people. Now a car park is a different thing, but the shopping center itself, safe.

You cannot ever just outright accomplish the end result, as you will likely fail, thus the failure will instill that your irrational fear was right, all because you did it wrong.

Use a graduated process with fear based exposure therapy... always graduated. Severity must be factored in.

A typical exposure using graduated steps, and our classic example, crowds, could go something like this:

• Week 1 - Drove into car park of shopping center, drove around it for 10 minutes, prepared to be patient and wait for drivers parking, exiting, etc... then drive out, never actually parking, just driving around within the car park learning patience with parking cars. Exit, go home, assess, did anything bad happen?
• Week 2 - Park car in car park, get out and walk into shopping center, stand at door and watch others, observe, acknowledge people entering and leaving without any issue. Identify coffee shop location. Get in car and go home.
• Week 3 - Using identified coffee shop, park car, walk into shopping center coffee shop, order drink, sit where you feel safe within the shop. Take in surroundings, others, even chat with someone if you will. Leave and go home.
• Week 4 - Repeat week 3, except this time sit at a table in the center of the shop, or atleast so your not against a wall, IF you insist on that type of seating to begin with. Order another drink on exit to go, takeaway... now whilst sipping that drink, go for a walk around the shopping center, and focus on how everyone just flows through, swerving around one another, even bumping into one another... then leave.
• Week 5 - Get takeaway drink, go window shopping for a longer period. If you find something annoying, ie. people who stand in the middle of the isle looking in a window, then you do that as well, acknowledge that you also have the right to stop and look, hence you're in a shopping center... and apply to them when you come across them, so no longer are they annoying, they are just shopping / socialising.
• Week 6 - Continue to gradually stepup exposure and duration, constantly expanding your tasks each time.

Eventually, you will find a boundary that no matter how much you try, you simply will not get beyond. Now you have your limit.

Example: Mine is around 6 - 8 straight hours in an internal shopping center, ie. no outdoor mall, or in and out of external shops, all one indoor shopping center. (aka: mall to US folk)

Yet if I go in and out of such place during a day, I can continue shopping like anyone else can. Find the boundaries, push them hard to expand them, but recognise when you have found them. Don't be soft and just roll over and giveup when it gets a bit hard, and say that's a boundary, as that is not what I'm saying above.

You are going to intentionally emotionally hurt yourself, wear yourself out doing such therapy... but the end result is that you can get back into life.

Expand crowds when you master shopping centers to a small concert / theatre production, then move up to a larger audience, ie. football game / sporting event, then major music concert or such... each time focusing afterwards on the reality... you are just one of the crowd doing your thing. You will get annoyed by others, just as you may annoy someone. Keep your calm, when you get to upset, leave... then try try again, until you accomplish your goals.

 

[maddog]

Thinking about this lots tonight, not sure why really. Specifically thinking about the fine line between unintentionally using trauma therapy to wallow in the past and hold yourself back from positive progress, versus processing the past in a productive way that helps you build a better present and future.

My T and I have discussed and debated this fine line extensively, which in and of itself has been healthy and very good for empowerment and allowing me to take control of the situation a little more. I think we have a balance that is the right one for me right now, in spite of the fact that its current impact on my coping abilities is beyond what it feels as though I can tolerate.

We are working a lot with old memories, childhood ones specifically, and those into adolescence and early adulthood. "Working" with them entails a lot of discussion, imaginal exposure, debriefing, discussing, validity testing, validation, exploring the various roles of my family members and myself, apportioning and reapportioning responsibility, linking early experiences to current personality traits and tendencies through schema-focused therapy, which I have to say is one of my favourite therapeutic approaches to date.

Yes, for me, this involves enormous amounts of what could crudely be classed as wallowing. Speaking about these memories and confronting their significance and all of their unresolved trauma is more distressing for me than I can explain right now. It's messy, ugly, horrible. Yet I truly believe it's necessary and healthy. I have to believe that...

But my T is very good about drawing and adhering to boundaries of time and extent when it comes to such exposure. He insists that we stop at some point and address current issues - current coping, current challenges and proactive future strategies. We never part at the end of a session still stuck in the past, but always having addressed a current issue. I think this not only is very healthy from a grounding and personal safety perspective, but it's also important in terms of reinforcing the need to look forward, using the past only as a means of guiding the way into the future.

It makes me feel a little better to try to articulate this situation in a positive light. And I really do believe it rationally - I think he's found a good balance for us, but God, it's hard...

Maddog

 

[Jacquie]

Every therapy uses cognitive and exposure components, whether you know it or not... so trying to justify that exposure therapy is not right for you, is trying to justify that no therapy is right for you... and you simply love misery instead.

No they dont
No it isnt
No I dont

Sorry Anthony but your repeated pointed comments at me are out of line. If you feel like putting someone down, grab a stuffed bear and scream at it. But please stop doing it to me.

thank you

 

[Tinyflame]

Anthony, if point number one (home environment) can't be met, is there a way around it? That is, (obviously) my attitude towards the environment and responses, but perhaps also "putting blinders" on?, etc. Because it cannot be changed, but could there be a way around that one?

Thanks for your thoughts/ ideas, I am willing to try something novel.

 

[anthony]

I would ask, what can't be met, to provide a more specific response.

Most things can be compromised / adapted... and no, sometimes there just are no feasible immediate alternatives, and you have to adapt and work with what you have. More often than not, there are alternatives, its just a matter of finding them and the hardest part, implementing them.

Its like talking with someone in a domestic abuse situation... they will tell you that they cannot leave, they cannot abandon their partner, even though that person is physically abusing them, the children, etc. In their mind they can't leave, because they cannot see beyond their own reality. There is usually also fear from any abuser, threats, etc... if you leave me, I'll kill you, type statements.

When the person eventually grows beyond the fear, usually the point they have accepted they just don't care if they die or not, then they leave and the majority of the time no further repercussions occur from all the threats of the abuser, hence why they are threats. Threats and fear are motivation to keep control of a person.

You would need to be more specific with me, to be perfectly honest... before I would agree or diagree that alternatives exist, based on the situation... as no two are the same.

No they dont
No it isnt
No I dont

Which therapies don't use a cognitive and exposure element Jacquie?